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NPI Code Detail

MEDICARE: BRYAN ASTUDILLO

MEDICARE: BRYAN ASTUDILLO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1689142408
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN ASTUDILLO
Provider Business Mailing Address
First Line : 4325 N RANCHO DR STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3439
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4325 N RANCHO DR STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3439
Country : US
Telephone Number : 702-820-8891
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2018
Last Update Date : 11/09/2018

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Directions to “ BRYAN ASTUDILLO ” Practice Location

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